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Indian Journal of Trauma and Emergency Pediatrics 17(2):p 43-47, July - Dec. 2025. | DOI: 10.21088/ijtep.2348.9987.17225.1
Review Article
PARDS 2.0: A Contemporary Review of the PALICC-2 Guidelines
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Attribution-Non-commercial 4.0 International (CC BY-NC 4.0)This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator.
Indian Journal of Trauma and Emergency Pediatrics 17(2):p 43-47, July - Dec. 2025. | DOI: 10.21088/ijtep.2348.9987.17225.1
How Cite This Article:
Yadav S. PARDS 2.0: A Contemporary Review of the PALICC-2 Guidelines. Indian J Trauma Emerg Pediatr. 2025;17(2):43–7.Timeline
Received : November 25, 2525
Accepted : December 20, 2025
Published : December 31, 2025
Abstract
Pediatric Acute Respiratory Distress Syndrome (PARDS) remains one of the most significant causes of respiratory failure, morbidity, and mortality in pediatric intensive care units worldwide. The first Pediatric Acute Lung Injury Consensus Conference (PALICC-1) in 2015 provided the inaugural pediatric-specific ARDS definition, addressing limitations of adult criteria. Since then, advances in pediatric respiratory support, especially high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), and lung-protective invasive ventilation have necessitated updated clinical recommendations. The Second International Guidelines (PALICC-2), released in 2023, represent a comprehensive revision of PARDS definitions, diagnostic thresholds, severity classification, monitoring protocols, and management strategies. This article synthesizes these updates by integrating the PALICC-2 Executive Summary and contemporary review published in 2023. The review explores revised diagnostic criteria incorporating noninvasive modalities, introduction of “possible PARDS” and “at-risk for PARDS” categories, restructured severity classification, and updated management practices spanning oxygen therapy, NIV, lung-protective mechanical ventilation, monitoring, sedation, fluid balance, nutrition, ancillary therapies, and ECMO. Emphasis is also placed on special populations, resource-limited settings, implementation challenges, and long-term outcomes. PARDS 2.0, as articulated through PALICC-2, offers a more inclusive, pragmatic, and physiologically relevant framework designed to improve early recognition, standardization of care, equity, research continuity, and global applicability.
References
- 1. Executive Summary of the Second International Guidelines for the Diagnosis and Management of Pediatric Acute Respiratory Distress Syndrome (PALICC-2). Uploaded PDF: /mnt/ data/executive_summary_of_the_second_ international.8.pdf; 2023.
- 2. PARDS: Updates in Light of PALICC-2 Recommendations. Uploaded PDF: /mnt/ data/tap-60-4-362.pdf; 2023.
Data Sharing Statement
There are no additional data available. All raw data and code are available upon request.
Funding
This research received no funding.
Author Contributions
All authors contributed significantly to the work and approve its publication.
Ethics Declaration
This article does not involve any human or animal subjects, and therefore does not require ethics approval.
Acknowledgements
We would like to express our gratitude to the patients, their families, and all those who have contributed to this study.
Conflicts of Interest
No conflicts of interest in this work.
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Cite this article
Yadav S. PARDS 2.0: A Contemporary Review of the PALICC-2 Guidelines. Indian J Trauma Emerg Pediatr. 2025;17(2):43–7.
Licence:
Attribution-Non-commercial 4.0 International (CC BY-NC 4.0)This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator.
| Received | Accepted | Published |
|---|---|---|
| November 25, 2525 | December 20, 2025 | December 31, 2025 |
DOI: 10.21088/ijtep.2348.9987.17225.1
Keywords
Pediatric Acute Respiratory Distress SyndromePARDSPALICC-2 GuidelinesPediatric Critical CareNon-invasive VentilationHigh-Flow Nasal CannulaOxygenation IndexLung-ProtectiveVentilation;Pediatric Mechanical VentilationResource-Limited SettingsLong-Term OutcomesSearch for Similar Articles
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Timeline
| Received | November 25, 2525 |
| Accepted | December 20, 2025 |
| Published | December 31, 2025 |
licence
Attribution-Non-commercial 4.0 International (CC BY-NC 4.0)
This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator.
